Highlights
- •Newly initiated PPIs and hospitalization due to hyponatremia was associated.
- •Lansoprazole was an exception with no association found.
- •In severe hyponatremia with newly initiated PPI, consider an alternative.
- •If the indication for PPI use remains, lansoprazole could here be an option.
- •Severe hyponatremia was not associated with ongoing PPI treatment.
Abstract
Background
Small observational studies and case reports have indicated that proton pump inhibitors
(PPIs) may cause hyponatremia. Whether there is a difference between the individual
PPIs is yet unknown. Since PPIs are one of the most commonly prescribed groups of
drugs, even a rare adverse reaction may have large implications. The objective was
to study the association between PPIs and hospitalization due to hyponatremia.
Methods
This register–based case–control study was based on the general Swedish population.
Patients hospitalized with a principal diagnosis of hyponatremia (n = 14,359) were compared to matched controls (n = 57,383). The association between newly initiated (≤90 days) and ongoing PPI use
was explored using multivariable logistic regression adjusting for concomitant drugs,
medical conditions, previous hospitalizations and socioeconomic factors.
Results
Adjusted ORs (95%CI) for hospitalization due to hyponatremia, compared to controls,
were for newly initiated: omeprazole 2.67 (2.37–3.01); pantoprazole 2.06 (1.32–3.19);
lansoprazole 1.19 (0.72–1.94); esomeprazole 2.89 (2.21–3.79) and any PPI 2.78 (2.48–3.11).
Only one individual had been newly initiated on rabeprazole and had been hospitalized
due to hyponatremia. Adjusted ORs (95%CI) for individuals with ongoing treatment were
for: omeprazole 1.04 (0.97–1.11); pantoprazole 0.81 (0.62–1.05); lansoprazole 0.90
(0.70–1.15); rabeprazole 3.34 (0.84–11.43); esomeprazole 1.12 (0.94–1.33) and any
PPI 1.04 (0.98–1.11).
Conclusions
With the exception of lansoprazole, this study suggests an association between any
newly initiated PPI-treatment and hospitalization due to hyponatremia. Ongoing PPI
use was not associated with an increased risk.
Keywords
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Article info
Publication history
Published online: August 25, 2018
Accepted:
August 21,
2018
Received in revised form:
August 19,
2018
Received:
July 25,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Corrigendum to: Associations of proton pump inhibitors and hospitalization due to hyponatremia: A population–based case–control study. Eur J Intern Med. 2019 Jan;59:65-69European Journal of Internal MedicineVol. 91
- PreviewThe authors regret that in preparation of a new article based on the same data as in the previous published article [1], we unfortunately discovered two errors in the dataset. Some cases of hyponatremia as a secondary diagnosis had erroneously been included as primary diagnosis of hyponatremia. The corrected number of cases admitted with a primary diagnosis of hyponatremia decreased to 11,213 instead of 14,359 as reported in the article, and as a consequence the number of matched controls decreased to 44,801 instead of 57,382.
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